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X-ray scanner could improve breast cancer surgery

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Researchers in the UK have developed a novel X-ray imaging scanner that could help surgeons performing surgery to remove breast tumours.

Most breast cancer operations are what are known as conserving surgeries, which remove the cancerous tumour rather than the whole breast. But the issue with this is that second operations are often required if the margins (edges) of the extracted tissue are found to not be clear of cancer.

To overcome this, researchers at University College London (UCL), Queen Mary University of London, Barts Health NHS Trust, and Nikon have devised a new approach to X-ray imaging that allows surgeons to assess extracted tissue intraoperatively, or during the initial surgery. The experts said this gives around two times better detection of diseased tissue in the margins than with standard imaging.

In the paper, published in Scientific Reports, the academics used X-Ray Phase Contrast Imaging (XPCI), developing a scanner that provides surgeons with a full 3D image of the extracted tissue lump, known as a wide local excision (WLE).

Currently, the WLE is assessed through histopathology – the microscopic examination of tissue – with results only available after several days. If affected margins are detected, often a second operation is required.

“I am terribly excited about these results, as they are likely to lead to the first clinical use of XPCI,” said lead author Professor Alessandro Olivo at UCL. “The technology has tremendous potential, and I am sure once people see what it can do many other clinical areas will follow suit.”

The researchers tested the scanner on 101 WLEs and compared the results with the current standard method used intraoperatively (based on conventional X-rays). They found that the superior detection rate of 2.5 times could result in a similar reduction in the re-operation rate.

XPCT compared to conventional imaging

Examples of the imaging performance of XPCI-CT (b,e) compared to conventional specimen radiography (a,d) and benchmarked against histopathology (c,f). The top row focuses on the similarity between the XPCI-CT slice in (b) and the histological slice in (c). Arrow 1 indicates margin involvement, arrow 2 a variation in density in the internal structure of the tumour mass, arrow 3 tumour-induced inflammation. All this is confirmed by the histological slice in (c), and hardly visible in the conventional image in (a). The bottom row focuses on the detection of small calcifications, a key feature in DCIS. These are undetectable in (d), detected in (e), enhanced in the maximum intensity projection (MIP) image at the bottom of (f), and confirmed by histopathology in the top part of (f). The scale bar [shown in (b) and (e)] is the same for all images apart from (f), which has its own scale. Red arrows in (e) and (f) indicate the microcalcifications.

Image credit: Professor Alessandro Olivo

Co-author Professor Louise Jones, the director of Breast Cancer Now Tissue Bank, said: “This technology has the potential to significantly improve radiological intraoperative assessment of tumour margins, potentially reducing the need for repeat operations that many patients require, which can cause significant distress to the patient.”

Meanwhile, Tamara Suaris, a consultant breast radiologist at Barts NHS Health Trust, added that although the team has focused on the impact of XPCI in breast surgery, there is a much wider clinical potential of this technology. This includes other intraoperative areas such as intestinal, oesophageal, and prostatic surgery and in the longer term, diagnostic imaging, notably mammography. 

According to the researchers, XPCI imaging provides soft tissue sensitivity which is superior to conventional X-ray. Whereas standard imaging picks up the X-ray beam’s change in intensity as it travels through tissue, phase contrast imaging measures the changes in speed with which X-ray travels through different tissues, which has been proven to enhance soft-tissue contrast, including of breast tumours.

The research was supported by the Wellcome Trust, the Royal Academy of Engineering, and the Royal Society. Tissue samples were collected and made available by the Breast Cancer Now Tissue Bank, donated by anonymous patients.

In November last year, the inventor of a home breast cancer screening device called ‘The Blue Box’ won a top prize at the 2020 James Dyson Awards. Meanwhile, in early 2020, a study found that an AI programme proved as effective as expert radiologists at detecting breast cancer based on screening mammograms, and showed promise of reducing error. 

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